Login to Access Video or Poster Abstract: MP90-16
Sources of Funding: MSI Foundation - Edmonton, Alberta

Introduction

A majority of patients with acute renal colic are discharged from the emergency department (ED) after initial diagnosis and symptom management. Unfortunately 20-30% of these patients require repeat ED visit for ongoing symptom control and 15%-25% require urgent urological intervention. If these patients destined for outpatient failure could be identified prior to discharge, they may benefit from early intervention to reduce morbidity as well as reduce health care expenditure of a repeat ED visit. Our objective was to identify predictors of outpatient treatment failure, defined as the need for hospitalization or urgent intervention within 60 days of ED discharge.

Methods

Prospectively gathered administrative data from 4 hospitals in Calgary, Alberta, Canada of patients with an ED diagnosis of renal colic from January 1st, 2014 to December 31st, 2014 was collected. Imaging reports were reviewed for stone characteristics. Data was linked to regional hospital databases to identify ED revisits, hospital admissions and surgical procedures. Patients were excluded if they were non-residents of Calgary or if they had a previous renal colic visit within 30 days.

Results

Of 3104 patients with first ED visit for acute renal colic, 1081 were discharged without intervention for a trial of spontaneous passage. Median patient age was 50 and 72% were males. As per table 1, on multivariate analysis we demonstrate the only predictor for outpatient treatment failure was proximal and mid-ureteric stone location. We found no association between gender, degree of hydronephrosis or stone size.

Conclusions

Using a prospectively gathered database we demonstrate patients with stones in their proximal or mid ureter are almost 3 times as likely to require 60-day hospital readmission or urgent intervention. Our results demonstrate treatment options should be considered for these patients prior to discharge.

Funding

MSI Foundation - Edmonton, Alberta